title: Route selection for double balloon enteroscopy in patients with obscure gastrointestinal bleeding: experience from a single center.
abstract: OBJECTIVE
  This study was performed to clarify the best insertion route of double-balloon enteroscopy and to report the characteristics and proportions of small bowel pathologies detected by double-balloon enteroscopy in our patients with obscure gastrointestinal bleeding.
  
  
  METHODS
  Between January 2006 and December 2009, 75 patients with obscure gastrointestinal bleeding were enrolled into this study. The procedure was performed by oral route in 60 patients, anal route in 5 patients and both in 10 patients. Mean age of the patients was 50.8 years, and 57.3% of them were male. The main outcome measurements were total length of insertion, total time of double-balloon enteroscopy, diagnostic rates, anatomic location of the lesions, and final diagnosis of lesions detected.
  
  
  RESULTS
  Double-balloon enteroscopy was diagnostic in 75% of the patients. This rate was significantly higher in overt bleeding (91.7%). The source of bleeding could not be detected in 19 patients. Mean times of procedures were 119, 144 and 154 minutes for oral route, anal route and both, respectively. The mean insertion length was 310.65 cm (beyond the pylorus)for oral and 166.8 cm (beyond the ileocecal valve) for anal route. The most frequent pathologies were vascular malformations (n=20) and tumors (n=19). All malignant lesions were detected in the proximal part of the small intestine. Vascular malformations were distributed equally through the small intestine. Endoscopic treatment was performed in 30% of patients.
  
  
  CONCLUSIONS
  Double-balloon enteroscopy is a safe and feasible examination for obscure gastrointestinal bleeding. Most lesions were localized in the proximal part of the small intestine. The oral route may be preferred as a first choice, if the imaging modalities including capsuleendoscopy cannot detect the lesion.
authors.affiliation: Department of Gastroenterology, Yeditepe University School of Medicine, İstanbul, Turkey. umitakyuz@yahoo.com
authors.forename: Ümit
authors.initials: Ü
authors.lastname: Akyüz
authors.forename: Cengiz
authors.initials: C
authors.lastname: Pata
authors.forename: Murat
authors.initials: M
authors.lastname: Kalayci
authors.forename: Kamil
authors.initials: K
authors.lastname: Özdıl
authors.forename: Hasan
authors.initials: H
authors.lastname: Altun
authors.forename: Bora
authors.initials: B
authors.lastname: Karıp
authors.forename: Filiz
authors.initials: F
authors.lastname: Akyüz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D058582:Double-Balloon Enteroscopy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000473:pathology*; D006801:Humans; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D055815:Young Adult